Addressing female genital mutilation in Europe: a scoping review of approaches to participation, prevention, protection, and provision of services.

BACKGROUND: Public and policy attention to female genital mutilation (FGM) in diaspora communities has increased in Europe, but research remains limited and misinformation abounds. As a first step to addressing these issues, this study explored FGM prevention and response interventions in Europe, using a scoping literature review and key informant interviews. METHODS: A scoping study design was selected, using Arksey and O'Malley's six-stage scoping framework to review identified sources. Key informant interviews were used to inform and add depth to literature findings. Findings were summarised thematically, guided by the Scottish Government's '4Ps' framework for tackling violence against women (i.e. participation, prevention, protection, providing services). RESULTS: Seventy literature sources, of 1095 screened, plus 16 individual and 3 group interview sources were included. Several countries have developed promising interventions supporting FGM resistance and recovery. However, gaps remain including community participation, professional knowledge and linkages, and evaluation of approaches. CONCLUSIONS: This scoping review is an initial attempt to describe available primary evidence on European initiatives responding to FGM. Further research is required to determine whether interventions are effective, while policy and practice development must be shaped and driven by the experiences, needs, and views of affected communities

Missing from the debate? A qualitative study exploring the role of communities within interventions to address female genital mutilation in Europe.

INTRODUCTION: Public attention on female genital mutilation (FGM) in diaspora communities is increasing in Europe, as health and social welfare implications become better understood. This study explored the role of potentially affected communities within interventions to address FGM in Europe, examining current practices, promising interventions and remaining gaps. METHODS: A qualitative study design incorporated 18 individual key informant interviews and five semistructured group interviews with policy-makers, service providers and community representatives. Data were analysed thematically, guided by the Scottish Government '4Ps' framework for addressing violence against women and girls, that is, prevention, protection, provision of services and participation. RESULTS: Participants emphasised both the importance of community participation and the lack of consistent engagement by policy-makers and practitioners. All indicated that communities had a key role, though most interventions focused on awareness-raising rather than community empowerment, behaviour change or influence on the design, delivery and/or evaluation of interventions. CONCLUSIONS: Despite clear consensus around the need to engage, support and empower potentially affected communities and several examples of meaningful community participation in addressing FGM (eg, REPLACE, REPLACE 2, Ketenaapak, Tackling FGM Initiative), the role of communities remains inconsistent and further engagement efforts are necessary

Expanding the genetics of microcephalic primordial dwarfism

Body mass varies considerably between different mammals and this variation is largely accounted for by a difference in total cell number rather than individual cell size. Insights into mechanisms regulating growth can therefore be gained by understanding what governs total cell number at any one point. In addition, control of cell proliferation and programmed cell death is fundamental to other areas of research such as cancer and stem cell research. Microcephalic Primordial Dwarfism (MPD) is a group of rare Mendelian human disorders in which there is an extreme global failure of growth with affected individuals often only reaching a height of around one metre in adulthood. To date, all identified disease genes follow an autosomal recessive mode of inheritance and encode key regulators of the cell cycle, where mutations impact on overall cell number and result in a substantially reduced body size. MPD therefore provides a valuable model for examining genetic and cellular mechanisms that impact on growth. The overall aims of this thesis were to identify novel disease causing genes, as well as provide further characterisation of known disease causing genes, through the analysis of whole exome sequencing (WES) within a large cohort of MPD patients. Following the design and implementation of an analytical bioinformatics pipeline, deleterious mutations were identified in multiple disease genes including LIG4 and XRCC4. Both genes encode components of the non-homologous end joining machinery, a DNA repair mechanism not previously implicated in MPD. Additionally, the pathogenicity of novel mutations in subunits of a protein complex involved in chromosome segregation was assessed using patient-derived cells. These findings demonstrate WES can be successfully implemented to identify known and novel disease causing genes within a large heterogeneous cohort of patients, expanding the phenotype of known disorders and improving diagnosis as well as providing novel insights into intrinsic cellular mechanisms critical to growth

Stage III Non–Small-Cell Lung Cancer: Population-Based Patterns of Treatment in British Columbia, Canada

Introduction:Management of Stage III non–small-cell lung cancer (NSCLC) involves surgery, radiotherapy (RT), chemotherapy, and best supportive care. The aims were to describe the patterns of treatment in a population-based cohort of patients, and compare utilization of RT and chemotherapy to model estimates of need.Methods:Patients diagnosed with Stage III NSCLC between January 1, 2000, to December 31, 2007, were identified from the British Columbia Cancer Agency database. Patients who had prior or concomitant malignancy were excluded. Patient demographics, tumor characteristics, and initial treatment were extracted. Survival data were derived from the British Columbia Vital Statistics Death Listings.Results:2365 patients with Stage III NSCLC were referred, of which 212 patients were excluded, leaving 2153 patients in the study population. Median age was 69 years. Disease stage was IIIA in 49% and IIIB in 51%. Histologies were squamous-cell carcinoma (31%), adenocarcinoma (27%), NSCLC not otherwise specified (31%), and other pathology (11%). Initial treatment included surgery in 12%, RT in 78%, and chemotherapy in 31%. Predicted RT utilization was 77% to 87% and chemotherapy 78%. From 2000 to 2007, curative-intent treatment increased from 21% to 35%, chemoradiotherapy from 8% to 18.6%, and concurrent chemoradiotherapy from 5.1% to 17.6%. Median survival was 30 months for patients who had curative surgery, 21 months for curative RT, 8 months for palliative treatment, and 5 months for best supportive care (p < 0.001).Conclusion:RT utilization was similar to that predicted by models whereas chemotherapy utilization was less. During the study period, the proportion of patients receiving curative chemoradiotherapy doubled and of those receiving concurrent chemoradiotherapy trebled

The impact of Covid-19 on research into work and health

Acknowledgments: We thank our research partners and funders for agreeing to disseminate information about the study (including link to the online survey) to their network contacts. We would like to thank all the study participants for completing the survey Funding: No external funding was used to conduct of this study. ED acknowledges funding from the Medical Research Council (MC_UU_00022/2) and the Chief Scientist Office (SPHSU17).Peer reviewedPostprin

An Examination of the Severe Impairment Battery as a Measure of Cognitive Decline in Clients with Down's Syndrome

The present study examined the validity of the Severe Impairment Battery (SIB) as a tool for measuring cognitive decline in clients with Down syndrome. Two groups participated: 10 clients who showed behavioural decline over at least a 2 year period as measured by the Vineland Adaptive Behaviour Scales, and 14 clients who showed no decline on this measure over the same period. No differences were found between the two groups in relation to health or life factors which may have impacted on functional and cognitive decline. The deteriorating group were found to be significantly older than the non-deteriorating group. The comparison of the SIB scores indicated that the deteriorating group showed a significant decline between baseline and 12 months and baseline and 24 months on the orientation factor. By contrast, for the non-deteriorating group, significant increases were found for praxis, orientating to name and total scores

Some injury scaling issues in UK crash research

This study explores the relationships between the classification of traffic casualties by the police and by using the AIS. It examines a sample of accidents to car occupants that have been studied through the CCIS data collection system in the UK. The results show that the police categories of ‘Slight’ and ‘Serious’ have poor correspondence with AIS rankings of the same individuals. In particular the ‘Serious’ police category includes a third of casualties who have either AIS 1or no injuries at all. The implications of these results on estimates of national casualties and costs are discussed. Some data from the EU indicate major variations in definitions of casualties from country to country making national comparisons uncertain

Determinants of acceptance of computer mediated communication system

Acceptance of Computer-Mediated communication Systems (CMCS) by managers and professionals corresponds to its incorporation into their daily patterns of communication and work. Acceptance includes at least three inter-related dimensions: amount of use, subjective satisfaction with the process of using the system, and a perception that system use has positive impacts upon productivity. Pre-use and follow-up questionnaires were distributed to 150- 250 new users of four different CMCS. Three are conferencing systems, designed to support group work. They differ in terms of comprehensiveness or complexity of design, and size and nature of the user communities; COM/KOM, a Swedish system with mostly European users, was included to provide a cross-cultural dimension. The fourth system is a commercially available electronic mail system used for internal communication within a single corporation. Users\u27 pre-use expectations are the strongest determinants of learning time, getting to know other people online, and subjective satisfaction with the system interfaces. Satisfaction with CMCS as a mode of communication, particularly for emotional or personal content, is most strongly affected by group-level variables. Those who have not previously communicated (offline) with group members and who do not like or trust them have the most problems with expressive communication via CMCS. Group membership and pre-use expectations in combination are the strongest determinants of amount of system use. The dropout rate varied from zero or 1% for some groups to over 50% for others. Among those who did use the three conferencing systems, the best predictor of cumulative time online at four months is the user\u27s own expectation of the amount of time that would be spent online, made at pre-use. In turn, expected usage is explained by a combination of importance of the online task; convenient access to a terminal, especially at home; and previous lack of regular communication channels with the online group. The pattern for the internal mail system was quite different; regular previous communication with the online group (rather than its absence) is correlated with use. The strongest correlate is an expectation that using the system will be hard; those who thought so simply did not use the electronic mail system. The contrasting pattern of association underscores the quite different functions of the two types of CMCS. Mail systems are used as a supplementary channel of communication to support ongoing communication within an organization. Conferencing system usage is maximized when it represents a new opportunity to communicate with others who were not conveniently available via traditional channels, about an important task. An experimental intervention in training and user support suggests that interactive online tutorials can be an effective learning mechanism and increase time online. The placement of a single personal telephone call offering assistance did not increase amount of use, within the context of the availability of a variety of other sources of information and support. Two factors comprising productivity impacts were identified. PRODUCTive is comprised primarily of improvements in the quantity and quality of work, the overall usefulness of the system, and improvements in the ease of reaching people. CAREER encompasses contributions to long-term and short-term career advancement, and the provision of information and ideas. The strongest correlates of PRODUCTivity improvements, for all four systems, are pre-use expectations about whether the system would increase productivity. The second strongest determinant appears to be the perceived leadership skill of the group moderator or leader. Another group-level variable, the level of satisfaction with previous channels of communication with one another, also significantly adds to predictions of productivity increases as a result of system use. Four process variables play an important part in determining positive productivity outcomes. One is the perceived value of the items contributed by the other group members. Another is time spent online, which is positively related to perceived productivity impacts, once pre-use expectations and motivations have been taken into account. A third is whether or not there were mode problems encountered, and the fourth , how many new people users came to know online. SYSTEM software differences do appear to make a significant impact on whether or not there will be productivity increases; but system enters the stepwise regressions in only fifth or sixth place, or not at all, depending on the combination of candidate variables entered. The best equations for predicting productivity increases are markedly different for the four systems. This is the main impact of software differences: given four basically well designed but quite different CMCS, the social context and software differences will interact to affect the most productive way to use the system. The best overall predictor of whether CMCS use will be seen to lead to CAREER advancement is whether the user was able to adequately express social-emotional content in communications in this mode. For individual systems, the specific variables and factors which are included in the best stepwise multiple regression equation to explain variations in CAREER vary markedly from one system to another, but all the equations include a subjective satisfaction factor in the selected variables. Career advancement depends to a large extent on strengthening and widening personal relationships with a network of peers and hoped-for peers. Thus, it is reasonable that this process was most likely to occur for those users who felt most comfortable and satisfied with the system as a communication mode. Only then is a user likely to go beyond the immediate task-oriented online activities and engage in the kinds of information exchanges and relationship-strengthening exchanges that may be related to general career advancement rather than just the efficient completion of a specific task at hand